What is a Stroke - St. Alexius Medical Center

st.alexius.org

What is a Stroke - St. Alexius Medical Center

St. Alexius Stroke Center


Contents

1) About St. Alexius Medical Center ................................................ 1

a) Map – How to Find Us

2) Impact of Stroke ............................................................... 3

3) Introduction .................................................................. 4

4) Part One: Understanding Stroke ................................................. 5

a) What is Stroke?

b) Warning Signs of Stroke

c) FAST

d) Stroke is an Emergency

e) Risk Factors for Stroke

f ) Stroke Prevention

5) Part Two: Diagnosis and Treatment of Stroke ..................................... 14

a) Diagnosing Stroke and Stroke Risk

b) Stroke Treatment

c) Surgical Treatment Options

d) Interventional Radiology Treatment Options

6) Part Three: Patient Care at the St. Alexius Stroke Center ........................... 18

a) The St. Alexius Hospitalist Program

b) The St. Alexius Critical Care Program

7) Part Four: Going Home from the Hospital ....................................... 21

a) Discharge Planning

b) Medications

c) Follow-up Appointments

d) Blood Sugar and Blood Pressure Checks

e) Seek Help Immediately If

8) Part Five: Rehabilitation Following Stroke ....................................... 24

a) Rehabilitation Services at St. Alexius

b) Stroke Disabilities

c) Life After Stroke: Survivor and Caregiver


The following organizations were used as resources to create this patient guidebook. Copyright of the

information is retained by the original organization. These organizations do not endorse St. Alexius

Medical Center. For more information, please contact St. Alexius Medical Center, or one of these associations.

National Stroke Association

9707 E. Easter Lane

Centennial, CO 80112

phone: (800) 787-6537

www.stroke.org

American Heart Association

1005 12 Ave SE

Jamestown, ND 58401

phone: (800) 437-9710

www.americanheart.org

American Stroke Association

1005 12 Ave SE

Jamestown, ND 58401

phone: (800) 437-9710

www.strokeassociation.org


About St. Alexius

St. Alexius Medical Center is a 306-bed, full-service, acute

care medical center offering a full line of inpatient and

outpatient medical services, including primary and

specialty physician clinics; home health and hospice

services; durable medical equipment services and a fitness

and human performance center.

Since our founding in 1885, St. Alexius Medical Center

has been dedicated to serving the residents of central

and western North Dakota, northern South Dakota and

eastern Montana.

Besides the main campus located in Bismarck, North Dakota, St. Alexius owns and operates hospitals

and clinics in Garrison, ND and Turtle Lake, ND and manages the hospital and clinics owned by

Mobridge Regional Hospital in Mobridge, SD. St. Alexius also owns and operates a primary care clinic

in Mandan, ND and specialty and primary care clinics in Minot, ND.

St. Alexius Medical Center is a Roman Catholic organization whose sponsors are the Sisters of

St. Benedict of the Annunciation Monastery, Bismarck, ND and as an organization we follow the

Ethical and Religious Directives for Catholic Health Care Services as promulgated by the United

States Conference of Catholic Bishops.

“Let All Be Received As Christ.”

1


Map to St. Alexius

2


Impact of Stroke

• About 780,000 Americans each year suffer a new or recurrent stroke. That mans, on average, a

stroke occurs every 40 seconds.

Stroke kills more than 150,000 people each year. That’s about 1 of every 16 deaths. It’s the No. 3

cause of death behind diseases of the heart and cancer.

• On average, every 3 to 4 minutes someone dies of stroke.

• Of every 5 deaths from stroke, 2 occur in men and 3 in women.

• Americans will pay about $65.5 billion in 2008 for stroke-related medical costs and disability.

Stroke is the leading cause of longterm disability in the US and the No.1 reason for admission to

longterm care facilities.

3


Introduction

The St. Alexius Stroke Center

The St. Alexius Stroke Center – one of the first

centers of its kind in North Dakota – is

pioneering new approaches to the diagnosis

and treatment of stroke that can significantly

improve patient chances for an optimal recovery.

New drugs, advanced surgical techniques and

innovative interventional procedures are among

the effective new medical options now available

for stroke patients.

The Center, founded in 1999, brings together

the expertise of specialists in many difference

areas to provide our patients with the benefit

of a collaborative team approach. The team

includes neurologists, neurosurgeons, interventional

radiologists, emergency medicine,

rehabilitation specialists, hospitalists and

intensivists, physical, occupational, and speech

therapists, and a dedicated nursing staff.

Our goals as a Stroke Center include improving

stroke care and ensuring that our stroke patients

receive optimal stroke treatment.

We have prepared this guidebook to provide you

with some important information about stroke.

The Guidebook explains the different types of

stroke, describes the warning signs and risk

factors for stroke, and recommends steps you can

take to reduce your risk for stroke. You will also

learn about advanced techniques for diagnosis

and treatment of stroke available at St. Alexius

Medical Center and information that will

prepare you for discharge and your recovery.

We want you to be familiar with the warning

signs and risk factors for stroke, and then take

the appropriate steps to change the risk factors

within your control so you can prevent another

stroke. Most importantly, if you or someone you

know should experience symptoms of stroke,

seek emergency help immediately – call 9-1-1 –

do not wait.

If you have any questions after reading this

guidebook, please feel free to call us at the

St. Alexius Stroke Center: (701) 530-6640.

Dr. S. Shiraz Hyder,

Director of the St. Alexius

Stroke Center, leads

a team of dedicated,

experienced physicians

and staff.

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Part One

Understanding Stroke

5


What is a Stroke

A stroke or “brain attack” occurs when a blood

clot blocks an artery (a blood vessel that carries

blood from the heart to the body) or a blood

vessel (a tube through which the blood moves

through the body) breaks, interrupting blood

flow to an area of the brain. When blood fails

to get through to the affected parts of the brain,

the oxygen supply is cut off, and brain cells begin

to die. When brain cells die during a stroke,

abilities controlled by that area of the brain are

lost. These abilities include speech, movement

and memory. How a stroke patient is affected

depends on where the stroke occurs in the brain

and how much of the brain is damaged.

Strokes fall into several major categories, based

on whether the disrupted blood supply is caused

by a blocked blood vessel (also known as an

ischemic stroke) or a burst blood vessel (also

know as a hemorrhagic stroke). Since each type

of stroke has a different type of treatment, it is

very important for the physician to determine

the cause of the stroke, as well as the location, as

quickly as possible.

Ischemic Stroke

Ischemic stroke occurs when arteries are blocked

by blood clots or by the gradual buildup of

plaque and other fatty deposits. Almost 85

percent of all strokes are ischemic. These fatty

deposits lining the vessel walls, also know as

atherosclerosis, can result in two types of

obstruction:

Thrombotic Stroke is the most common

type of stroke. In this type of stroke, blood

flow is impaired because of a blockage to

one or more of the arteries supplying blood

to the brain. The process leading to this

blockage is known as thrombosis or blood

clot. Strokes caused in this way are called

thrombotic strokes. That’s because the

medical word for a clot that forms on a

blood vessel deposit is thrombus. Sometimes

the clot occurs in one of the neck (carotid

or vertebral) arteries that transport blood

from the heart to the brain. Blood clots

form most often in arteries damaged by

atherosclerosis, a disease in which rough,

fatty deposits build up on the walls of the

arteries and project into the bloodstream.

These deposits gradually narrow the

passageway, causing the blood flow to

slow down and, sometimes, to completely

occlude (block) the artery.

Embolic Stroke is also caused by a clot.

In an embolic stroke, a blood clot forms

somewhere in the body (usually the heart)

and travels through the blood stream to the

brain. Once in the brain, the clot travels

through the arteries. As the arteries branch

into smaller vessels, the clot reaches a point

where it can go no further and plugs the

vessel, cutting off the blood supply. The clot

lodges there, blocking the blood vessel and

causing a stroke. The medical word for this

type of blood clot is embolus.

Hemorrhagic Stroke

The other main category of stroke, hemorrhagic

stroke, occurs when a blood vessel in or around

the brain breaks or bursts, spilling blood into the

brain or the area surrounding the brain. When

this occurs, the cells nourished by the artery

fail to get their normal supply of nutrients and

can’t function properly. Furthermore, blood

accumulates and compresses the surrounding

brain tissue.

Hemorrhagic strokes are frequently caused by

two types of weakened blood vessels: aneurysms

and arteriovenous malformations (AVMs).

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Aneurysms. An aneurysm is a ballooning

of a weakened region of a blood vessel. If left

untreated, the aneurysm continues to weaken

until it ruptures and bleeds into the brain.

Arteriovenous Malformations (AVMs).

An AVM is a cluster of abnormally formed

blood vessels. Any of these vessels can

rupture also causing bleeding in the brain.

Transient Ischemic Attacks (TIAs)

About one-third of all strokes are preceded by

one or more “mini-strokes,” known as transient

ischemic attacks (TIAs). TIAs can occur days,

weeks or even months before a stroke.

TIAs are caused by temporary interruptions in

the blood supply to the brain. The symptoms

occur rapidly and last a relatively short time,

usually from a few minutes to several hours,

always with complete recovery within 24 hours.

Because TIAs are temporary and the body soon

returns to normal, it is easy to ignore them or to

believe that the problem has disappeared. However,

it is dangerous to ignore TIAs, because

the underlying problem that caused the TIA

continues to exist. TIAs are often early warning

signs of more serious and debilitating stroke in

the future.

Common stroke symptoms include:

• Sudden numbness or weakness of the face,

arm or leg (especially on one side of the

body)

• Sudden confusion, trouble speaking or

understanding

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness, loss of

balance or coordination

• Sudden, severe headache with no known

cause

Learn to Recognize Stroke Symptoms. Call

9-1-1 immediately if you have any of these

symptoms. Learning the signs of stroke can save

precious time and precious brain function.

Note the time you experienced your first

symptoms. This information is important to your

healthcare provider and can affect treatment

decisions.

Diagnostic advances at the St. Alexius Stroke

Center have made it possible to diagnose these

important causes of stroke so treatment can be

arranged and offer patients the likelihood of a

cure.

Warning Signs of Stroke

Few Americans know the symptoms of stroke.

Learning them – and acting FAST when they

occur – could save your life or the life of a loved

one.

7


FAST

FAST

Using the easy mnemonic device “FAST” to

remember stroke symptoms can help to

get rapid medical treatment for stroke. If

the stroke symptoms come on abruptly or

are one-sided, CALL 911 immediately for

emergency treatment.

F: FACE

• Uneven smile

• Facial droop / numbness

• Vision disturbance

A: ARM & LEG

• Weakness

• Numbness

• Difficulty walking

S: SPEECH

• Slurred

• Inappropriate words

• Mute

T: TIME

• Time is critical

• CALL 911

8


Stroke is an Emergency

Call 9-1-1 if you see or have any of these

symptoms. Treatment can be more effective if

given early on. Every minute counts!

140/90 or above, it’s high. Talk to your doctor

about how to control it.

Special note: If symptoms appear for only a very

short period of time and then disappear, it could

mean a Transient Ischemic Attack or TIA. It’s

important to call 9-1-1 whenever you experience

any stroke symptom. While TIAs are not strokes,

they indicate serious underlying stroke risks and

are a powerful warning that a full stroke may

soon follow.

Getting emergency medical treatment is

important for several reasons: Only a doctor can

tell for sure if you are having a stroke or a TIA.

And, if you are having a stroke, emergency

medical treatment could save your life and

greatly improve your chances for successful

rehabilitation and recovery. If you are having a

TIA, your doctor will evaluate and treat the

underlying causes. Following your doctor’s

orders for medication and treatment can help

reduce your risk of having a stroke.

Risk Factors for Stroke

Knowing your risk for stroke is the first step in

preventing stroke. You can change or treat some

risk factors, but others you can’t.

Risk Factors for Stroke that can be

Changed, Treated or Controlled

• High Blood Pressure

This is the single most important risk factor

for stroke because it’s the No. 1 cause of stroke.

Know your blood pressure and have it checked

at least once every two years. If it’s consistently

• Tobacco Use

Don’t smoke cigarettes or use other forms of

tobacco. Tobacco use damages blood vessels.

The nicotine and carbon monoxide in cigarette

smoke damage the cardiovascular system in

many ways. The use of oral contraceptives

combined with cigarette smoking greatly

increases stroke risk.

• Diabetes Mellitus

Having diabetes increases your risk of stroke because

it can cause disease of blood vessels in the

brain. Many people with diabetes also have high

blood pressure, high blood cholesterol and are

overweight. Diabetes is treatable, but the presence

of the disease increases your risk of stroke.

Work with your doctor to manage diabetes and

reduce other risk factors.

• Carotid or Other Artery Disease

The carotid arteries in your neck supply most

of the blood to your brain. A carotid artery

damaged by a fatty buildup of plaque inside

the artery wall may become blocked by a blood

clot, causing a stroke.

9


• TIAs

Transient Ischemic Attacks (TIAs) are “mini

strokes” that produce stroke-like symptoms but

no lasting effects. Recognizing and treating

TIAs can reduce the risk of a major stroke.

Know the warning signs of a TIA and seek

emergency medical treatment immediately.

• Arterial Fibrillation or Other Heart Disease

This heart rhythm disorder raises the risk for

stroke. In atrial fibrillation, the heart’s upper

chambers quiver instead of beating, causing the

blood to pool and clot. If a clot breaks off, enters

the blood stream and lodges in an artery leading

to the brain, a stroke results. People with other

types of heart disease have a higher risk of

stroke, too.

• Certain Blood Disorders

A high red blood cell count makes clots more

likely raising the risk of stroke. Sickle cell anemia

increases stroke risk because the “sickled” cells

stick to blood vessel walls and may block arteries.

• High Blood Cholesterol

High blood cholesterol increases the risk of

clogged arteries. If an artery leading to the brain

becomes blocked, a stroke can result.

• Physical Inactivity and Obesity

Inactivity, obesity or both can increase your risk

of high blood pressure, high blood cholesterol,

diabetes, heart disease and stroke.

Risk Factors for Stroke That Cannot be

Changed

• Increasing Age

Stroke affects people of all ages. But the older

you are, the greater your stroke risk. The chance

of having a stroke approximately doubles for

each decade of life after age 55.

• Gender

In most age groups, more men than women have

stroke, but more women die from stroke. Use

of birth control pills and pregnancy increase a

woman’s risk of stroke.

• Heredity and Race

People whose close blood relatives have had

a stroke have a higher risk of stroke. African

Americans have a higher risk of death and

disability from stroke than whites, because they

have high blood pressure more often. Hispanic

Americans are also at higher risk of stroke.

• Prior Stroke

Someone who has had a stroke is at higher risk

of having another. A person who has had one

or more TIAs is almost 10 times more likely to

have a stroke than someone who is the same age,

sex and hasn’t had a stroke. Heart attack patients

are also at a higher risk of having a stroke.

• Excessive Alcohol Intake and Illegal Drug Use

Drinking an average of more than one drink per

day for women or more than two drinks a day

for men raises blood pressure. Drinking more

than two drinks per day may increase stroke

risk by 50%. Binge drinking can lead to stroke.

Abusing illegal drugs also carries a high risk of

stroke.

10


Risk Factors That Can Be Changed

• Hypertension (high blood pressure)

• Smoking

• Heart disease

• High cholesterol level

• Excess alcohol intake

• Obesity

• Sedentary lifestyle

• Diabetes

• Elevated hematocrit (increase in red blood cells) • Stress

• Use of oral contraceptives (especially for women who smoke)

Risk Factors That Cannot Be Changed

• Age

• Sex

• Race

• Family or individual history of stroke or TIA

Stroke Prevention

There are many positive steps that you can

take now to reduce your risk of stroke. Eighty

percent of strokes are preventable! The following

are the most important measures you can

take to control your stroke risk. These include

changing risk factors by medical treatment as

well as by positive lifestyle modifications.

Know Your Blood Pressure

High blood pressure (hypertension) is a leading

cause of stroke. Have your blood pressure

checked at least annually. If it is elevated, work

with your doctor to keep it under control. If

your doctor decides that you have high blood

pressure, she/he may recommend some changes

in your diet, regular exercise, or medicine.

Find Out if You Have Atrial

Fibrillation

Your doctor can diagnose atrial fibrillation (AF)

by carefully taking your pulse. Atrial fibrillation

can be confirmed or ruled out with an electrocardiogram

(ECG), a recording of the electrical

activity of the heart, which can probably be

done in your doctor’s office. If you have AF, your

doctor may choose to lower your risk for stroke

by prescribing medicines called blood thinners.

Aspirin and warfarin (Coumadin) are the most

commonly prescribed treatments.

If You Smoke, Quit!

Smoking doubles the risk for stroke. However,

your risk begins to decrease the day you quit.

NO

SMOKING

If You Drink Alcohol, do so in

Moderation

If you drink, we recommend no more than two

drinks each day, and if you don’t drink, don’t

start. Remember that alcohol is a drug and it

can interact with some drugs. Please ask your

doctor or pharmacist if any of the medicines you

are taking could interact with alcohol.

11


Know Your Cholesterol Numbers

If your total cholesterol level (LDL and HDL)

is over 200, talk to your doctor. You may be at

increased risk for stroke. LDL, known as the

“bad” cholesterol, is the form that builds up and

causes plaque which may narrow arteries and

limit or stop blood flow. LDL can be inherited

from your family members or be a result of your

body chemistry. It can also be the result of a diet

high in saturated fats, lack of exercise, or diabetes.

HDL is the “good” cholesterol that sweeps

the blood and removes plaque. Lowering your

cholesterol (if elevated) may reduce your risk

for stroke. High cholesterol can be controlled

in many individuals with diet and exercise, but

some individuals may require medications.

Exercise

Include exercise in your daily routine. A brisk

walk for as little as 30 minutes a day can improve

your health in many ways, and may reduce your

risk for stroke. If you don’t enjoy walking, choose

another exercise or activity that you do enjoy,

such as biking, swimming, gold, tennis, dance

or aerobics. Make time each day to take care of

yourself by exercising.

Treat Diabetes

Follow your doctor’s advice carefully to control

your diabetes. Often, diabetes can be controlled

through careful attention to what you eat. Work

with your doctor and a dietitian (a health care

professional who helps promote good health

through proper eating) to develop a healthy

eating program that fits your lifestyle. Your

doctor can prescribe lifestyle changes and

medication that can help control your diabetes.

Having diabetes puts you at an increased risk

for stroke; by controlling your diabetes, you may

lower your risk for stroke.

Maintain a Healthy Weight

Being overweight strains the heart and blood

vessels and is associated with high blood

pressure. Obesity also predisposes a person

to heart disease and diabetes, both of which

increase the risk for stroke. Keeping your weight

to recommended levels for your height and build

is a prudent preventive measure.

Enjoy a Lower Sodium (Salt),

Lower Fat Diet

By cutting down on sodium and fat in your diet,

you may be able to lower your blood pressure,

and, most importantly, lower your risk for stroke.

Work towards a balanced diet each day with

plenty of fruits, vegetables, grains, and a moderate

amount of protein (meat, fish, eggs, milk, nuts,

12


tofu, and some beans). Adding fiber, such as

whole grain bread and cereal products, raw,

unpeeled fruits and vegetables and dried beans,

to the diet can reduce cholesterol levels by 6 to

19 percent.

Circulation Problems (movement of the

blood through the heart and blood vessels)

Ask your doctor if you have circulation problems

which increase your risk for stroke. Your doctor

can check to see if you have problems in the

circulation supplying blood to your brain. Fatty

deposits can block the arteries which carry

blood from your heart to your brain. These

arteries, located on each side of your neck, are

called carotid and vertebral arteries. This kind

of blockage, if left untreated, can cause stroke.

Circulation problems can usually be treated with

medications. Occasionally, surgery is necessary

to correct circulation problems such as a blocked

artery.

Regular Medical Check-ups

Risk factors such as heart disease, high blood

pressure, and elevated blood cholesterol must be

monitored by your physician on a regular basis.

These risk factors can be changed or, at minimum,

controlled by proper medical treatment and

appropriate diet and lifestyle modifications.

Reduce Stress

Because stress may increase blood pressure, it

is linked indirectly to stroke risk. A one-time

stressful event rarely causes a stroke, but longterm

unresolved stress can contribute to high

blood pressure. Stress management, including

relaxation techniques, biofeedback, exercise and

counseling, appear to be useful in the treatment

of high blood pressure, thus lowering the risk of

stroke.

Symptoms

If you have any stroke symptoms, seek immediate

medical attention. These include:

• Sudden numbness or weakness of the face,

arm or leg (especially on one side of the

body)

• Sudden confusion, trouble speaking or

understanding

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness, loss of

balance or coordination

• Sudden, severe headache with no known

cause

If you have experienced any of these symptoms,

you may have had a TIA or mini-stroke. Ask

your doctor if you can lower your risk for stroke

by taking aspirin, or by other means. If you think

someone may be having a stroke, act FAST.

13


Part Two

Diagnosis and Treatment of Stroke

14


If you have shown symptoms of stoke or a TIA,

your doctor will gather information to make a

diagnosis. He or she will:

• Review your medical history

• Do a physical and neurological examination

• Have blood tests done

• Get a CT scan of the brain

• Order additional diagnostic testing,

if necessary

The St. Alexius Stroke Center has state-of-theart

brain diagnostic devices available to obtain

in-depth information about a patient’s status.

These highly sensitive tools are of critical

importance in diagnosing abnormalities that

place a patient at high risk for stroke, such as

a blocked blood vessel or the presence of an

aneurysm or AVM.

To obtain complete diagnostic information, it is

likely that several (but not all) of the following

diagnostic studies will be performed during an

evaluation for stroke or stroke risk.

Computerized Tomography (CT) Scan

is generally the first diagnostic test done for a

patient who is suspected of having a stroke. A

CT scan involves the use of low-dose x-rays to

visualize the brain. CT test results provide

information about the cause of stroke, location

and extent of brain injury.

Magnetic Resonance Imaging (MRI) uses a

large magnetic field to produce an image of the

brain. The MRI scan produces a sharper, more

precise image than CT scans and are used to

locate the exact area of the stroke. The precision

of an MRI is also helpful when small blood

vessels are affected.

Magnetic Resonance Angiography (MRA)

is a noninvasive study that gathers information

about how blood is flowing in the patient’s brain.

Carotid Ultrasound is a noninvasive study

used to diagnose blockage in the carotid arteries.

The study uses sound waves to track the speed

of blood flow through the carotid arteries and if

there is narrowing or blockage.

Transcranial Doppler (TCD) is a noninvasive

study that uses ultrasound (sound waves) to

check the blood flow through the blood in the

brain via a small probe placed against the skull.

TCD is one method used to monitor the

progress of a patient’s medical treatment.

PET Scanning, a highly specialized brain

image, measures brain cell metabolism to

determine if brain tissue is functioning even if

blood flow to that area appears to be diminished.

CT scans help distinguish the type of stroke.

Cerebral Angiography (angiogram) is a

diagnostic study that requires injection of a

contrast dye through a major blood vessel

(usually the femoral artery in the thigh) for

evaluation of blood flow to the brain.

15


Echocardiogram – also called an echo, uses

ultrasound waves to show a moving picture of

the size and shape of the heart, the valves, and

how the heart moves as it beats.

Stroke Treatment

Much of the damage caused by a stroke

occurs in the first six hours. Most strokes

can be treated.

Acute Treatment - Thromboyltics

The thrombolytic drug tPA (tissue plasminogen

activator), is the first FDA-approved acute

stroke treatment. This drug helps reestablish

blood flow to the brain by dissolving the clots

which are blocking the blood flow. To be

effective, thrombolytic therapy should be given

as quickly as possible. If given within the first

few hours after stroke onset, this drug may

dramatically minimize stroke damage.

Medications to Treat Stroke

A number of medications that help prevent

stroke in high-risk patients, particularly those

who have had a previous TIA or minor stroke.

These drugs fall into two major categories:

anticoagulants (such as warfarin [Coumadin]

or ximelgatran) and antiplatelet agents (such

as aspirin, dipyridamole [Aggrenox] and

clopidogrel [Plavix]).

Antiplatelet Agents

Antiplatelet medicine keeps blood clots

from forming by preventing blood platelets

from sticking together. Antiplatelet drugs

include aspirin, clopidogrel (Plavix) and

dipyridamole (Aggrenox).

Surgical Treatment Options

Surgery is an accepted way of preventing stroke

for patients with certain conditions.

Carotid Endarterectomy

Carotid endarterectomy is a procedure in which

blood vessel blockage is surgically removed from

the carotid artery. It has recently been proven

that for certain patients with minor strokes or

TIAs, carotid endarterectomy is highly beneficial

in preventing future strokes.

Angioplasty and Stenting of Vessels in the

Neck and Brain

Doctors sometimes use balloon angioplasty and

implantable steel screens called stents in the

vessels of the neck and brain to open partially

blocked blood vessels.

Anticoagulants

Anticoagulants or “blood thinners” are

medicine that delay the clotting of blood.

Two examples are heparin and warfarin

(Coumadin). They are also used for treatment

and prevention of blood clots in the

other blood vessels such as the leg or lungs.

16


Interventional Radiology

Treatment Options

In addition to new medications and surgical

techniques, The St. Alexius Stroke Center is

performing new interventional radiology

procedures to prevent stroke in patients.

Mechanical Devices

Mechanical devices are available to physically

remove blood clots that are blocking blood

vessels within the brain. One of the devices,

the MERCI Retrieval System, was recently

approved by the FDA. The device works like a

corkscrew to pull a clot out of bleed vessels. For

selected patients, devices such as the MERCI

retriever can effectively treat stroke even up to

8 hours after symptom onset.

Intra-Arterial Thrombolysis

A small catheter (tube) is threaded into the

brain during specialized brain imaging and clot

dissolving medications are delivered directly into

the blocked blood vessel.

Dr. Herbal, interventional radiologist, performs

specialized procedures for acute stroke

treatment.

17


Part Three

Patient Care at the St. Alexius Stroke Center

18


In addition to the diagnostic and therapeutic

services offered by the St. Alexius Stroke

Center, a full spectrum of allied patient care

services is available. To ensure that emergency

care is administered as quickly as possible to

stroke victims, the Emergency Department staff

provide an early and essential communications

link in the identification and treatment of stroke

patients.

After care in the Emergency Room or the

Intensive Care Unit (ICU), stroke patients

are generally admitted to the Inpatient Stroke

Unit for continued observation, treatment and

eventual rehabilitation. During their hospital

stay, patients will receive care from a dedicated,

interdisciplinary team.

The team includes:

• Physicians - including the patient’s primary

care physician and/or hospitalist, as well as

physicians on the neurology, neurosurgery,

critical care, interventional radiology and

anesthesiology services

• Nurses - assess and coordinate patient needs,

administer treatment, provide patient/family

instruction

• Nursing Assistants - provide personal care

and hygiene

• Physical, Occupational and Speech Therapists -

provide individualized rehabilitation treatment

• Social Worker - offers support to patient and

family, works to coordinate any appropriate

community resources

• Pastoral Care - offers spiritual support to

patient and family

• Case Management - oversees hospitalization

and coordinates with insurance payors, works

to insure follow-up arrangements such as

home care

• Dietitian - assists with proper design of

nutritional and caloric intake

Dedicated staff offer patient care on the

Stroke Unit.

The St. Alexius Hospitalist Program

During your stay at St. Alexius Medical Center,

you will be treated by many healthcare professionals.

Among them will be a group of doctors

known as hospitalists. A hospitalist is a medical

doctor who specializes in treating adult patients

in the hospital. The hospitalists work with

other healthcare professionals, including your

neurologist, to coordinate all aspects of your

treatment while you are a patient. The

hospitalists will communicate with your

regular doctor to arrange for care with your

doctor after you go home.

Dr. Uy,

Hospitalist,

part of the

stroke team.

19


The hospitalists are in the hospital around the

clock and are available to meet your medical

needs during your stay and to meet with you

and your family to discuss your treatment. If you

or a family member would like to speak with

your hospitalist, please notify your nurse so your

hospitalist can be paged.

The St. Alexius Critical Care

Program

The intensive/critical care unit at St. Alexius,

under the direction of 24-hour intensivists

(physicians specialized in the care of critically

ill patients), focuses on the care of critically ill

stroke patients who may need to be treated in

the intensive care unit. Patients who receive

thrombolytic therapy or who undergo interventional

procedures are often monitored for

12-24 hours in the intensive care unit. Patients

with more severs strokes may also be monitored

in the intensive care unit in order to more

closely monitor their neurologic, respiratory, or

circulatory functions.

Stroke patients needing Intensive Care treatment

are cared for by one of the St. Alexius

Intensivists.

20


Part Four

Going Home from the Hospital

21


Discharge Planning

The multidisciplinary planning team will involve

you and your family in planning for discharge.

If You are Going Home

Since you may not be permitted to drive following

your stroke, you will need to make arrangements

for someone to drive you home. You will receive

written discharge instructions concerning medication,

physical therapy, activity, etc. Additional

home equipment may be recommended and staff

will assist you with obtaining it.

If You are Going to a Swing Bed,

Rehab, or Skilled Nursing Facility

The decision to go home or to a swing bed,

rehab, or skilled nursing facility will be made

collectively by you and your family, the discharge

planning team, your physician, and your physical

therapist.

Medications

You will be provided with a list of medications

you are to be taking at the time of discharge.

Your nurse and/or physician will review your

medications with you prior to discharge and

provide you with prescriptions for any new

medications you are being discharged on. Keep

a written list of the medicine you take, the

amounts, and when and why you take them. Do

not use any medicines, over-the-counter drugs,

vitamins, herbs, or food supplements without

first talking to caregivers.

Always take your medicine as directed by caregivers.

Call your caregiver if you think your

medicines are not helping or if you feel you are

having side effects. Do not quit taking your

medicines until you discuss it with your caregiver.

Aspirin to stop blood clots: Aspirin helps

thin the blood to keep blood clots from forming.

If your doctor tells you to take aspirin, do not

take acetaminophen or ibuprofen instead. Do

not take more or less aspirin than your doctor

says to take.

Blood thinners: Blood thinners are medicines

that help prevent clots from forming in the

blood. Clots can cause strokes, heart attacks, and

death. Blood thinners may cause you to bleed or

bruise more easily. Do the following if you are

taking a blood thinner:

• Watch for bleeding from your gums or nose,

or in your urine or stool.

• Use a soft washcloth on your skin and a soft

toothbrush to brush your teeth. Doing this

can keep your skin and gums from bleeding.

• Tell your dentist before dental cleanings, and

other providers before other procedures, that

you take blood thinning medicine.

• If you shave, use an electeric shaver.

• Do not play contact sports since you may

bleed or bruise easily.

• Wear a MedicAlert bracelet or necklace that

says you are taking a blood thinning medicine.

You may get one from your local drugstore

or contact the MedicAlert Foundation.

22


Follow-Up Appointments

Your physicians will determine when and with

whom you need follow-up appointments. It is

important to keep these appointments so your

progress can be monitored. Please take a list

of your medications with you to your appointments.

Make a list of questions you might have

for your physician or provider before going to

the appointment so your questions can be

answered appropriately.

Blood Sugar and Blood

Pressure Checks

If you have diabetes, you will need to check

your blood sugar many times each day. Write

down your blood sugar level each time for your

provider to review. Your provider will tell you

what your blood sugar level should be.

If you have high blood pressure, you will need to

check and write down your blood pressure readings.

Caregivers will teach you or your family

how to check your blood pressure, and tell you

how often to do this. Keep track of your blood

pressure readings, along with the date and time

you took them. Take this record with you to

your doctor’s appointments.

Seek Care Immediately If:

• You have check pain that spreads to your

arms, jaw, or back.

• You have one or more of the following signs

or symptoms of a stroke:

• A very bad headache. This may feel

like the worst headache of your life.

• Confusion and problems speaking or

understanding things.

• Not able to see out of one or both of

your eyes.

• Too dizzy to stand, trouble walking,

or loss of balance

• Weakness or numbness of your face,

arm, or leg, especially on one side of

your body.

• You have trouble breathing.

This is an emergency – call 9-1-1. Ask for the

ambulance to take you to the nearest hospital.

Do not drive yourself.

23


Part Five

Rehabilitation Following Stroke

24


Because of the tremendous advances in stroke

treatment, along with the ever-increasing

sophistication of rehabilitation techniques, the

outlook for stroke patients has never been more

hopeful.

Rehabilitation actually starts in the hospital as

soon as possible after the stroke. In patients who

are stable, rehabilitation may begin within two

days after the stroke has occurred, and should

be continues as necessary after release from

the hospital. Depending on the severity of the

stroke, rehabilitation options include a rehabilitation

unit in the hospital, home therapy, home

with outpatient therapy or a long-term care

facility that provides therapy and skilled nursing

care.

The goal of rehabilitation is to improve function

so that the stroke survivor can become as

independent as possible. Successful stroke

rehabilitation is dependent on many factors,

including the severity of brain damage and

the cooperation of family and friends. Not

surprisingly, the attitude of the patient is a key

factor in speed and degree of recovery. A positive

outlook and high level of determination may

facilitate recovery. This must be accomplished in

a way that preserves dignity and motivates the

survivor to relearn basic skills that the stroke

may have taken away.

After a stroke, other blood vessels may be able

to take over for the damaged blood vessel. This

allows some cells to recover, although others

may still die. If the blood supply is cut off due to

a clot, the body works to dissolve the clot. This

means that the damaged part of the brain can

sometimes improve or return to normal without

rehabilitation. Most stroke patients, however,

will benefit from some type of rehabilitation.

Rehabilitation Services at

St. Alexius

St. Alexius offers a wide variety of rehabilitation

services for stroke patients, ranging from

inpatient services on the Comprehensive

Inpatient Rehabilitation Unit, as well as several

types of outpatient therapies. During all phases

of rehabilitation and recovery, survivors will most

likely work with a team of professionals. Both

survivors and caregivers should get to know everyone

on the healthcare team and feel comfortable

addressing any recovery issues with them.

Rehabilitation

is an important

part of stroke

therapy.

The recovery healthcare team can include:

• Physiatrists and Neurologists – who specialize

in physical medicine and rehabilitation and

determine the level of disability, monitor

health and treat any complications of stroke.

• Rehabilitation nurses – who assist patients to

make rehabilitation part of the daily routine

and help teach family members about strokerelated

disabilities, medication and other

treatment.

• Psychologist, social workers and care managers –

who counsel patients with emotional and

readjustment issues and provide support,

information and community resources.

25


• Physical, occupational and recreation therapists

and speech-language pathologists – who work

directly with stroke survivors and their

caregivers to address needs in physical,

communication, thinking and swallowing

abilities and to reintroduce leisure and social

activities back into a survivor’s life.

You may also work with an ophthalmologist or

optometrist who will diagnose and treat specific

problems with blurred vision, partial or complete

loss of sight. Different types of vision therapies

are available to retrain, strengthen, or sharpen

vision following stroke.

Stroke Disabilities

Different areas of the brain control different

bodily functions. When certain brain cells are

not able to function due to stroke, the parts of

the body controlled by those cells are also unable

to function. For instance, if the left side of the

brain is damaged, most of the effects will occur

on the right side of the body. It’s also important

to note that most areas of the brain will continue

to function normally, despite substantial damage

in other areas.

Life After Stroke: Survivor and

Caregiver

Strokes can be life changing for stroke survivors

and their caregivers. After a stroke, both stroke

survivors and the family can be concerned about

being on their own at home. Among the common

concerns are the fears that:

• Fear of another stroke

• Difficulty accepting the changes in how their

bodies and minds work

• Apprehension about keeping survivors at

home or moving them to assisted living

facilities

• Overpowering responsibilities of round-theclock

caregiving

• Fear of abandonment of friends and family

Some of the most common results of a stroke

are hemiparesis (paralysis on one side of the

body), aphasia (the loss of ability to speak or to

understand language), spatial-perceptual deficits,

learning difficulties, memory loss, behavioral/

emotional changes, and loss of motor skills.

If someone you know has suffered some of these

disabilities as a result of stroke, there are many

community resources available that can help you

cope with the situation and learn how to provide

the proper support and encouragement. The

St. Alexius Stroke Center can provide you with

an up-to-date list of community resources.

26


Memory Loss

Some changes in behavior, such as memory loss,

can be so subtle they may not be noticed at first.

The stroke survivor may be anxious and cautious,

needing a reminder to finish a sentence or know

what to do next. Some stroke survivors have

difficulty with numbers and calculating. Family

members will need to learn to keep things in the

same place, do things in the same sequence,

tell the stroke survivor in advance what is

going to happen and possibly take over some

responsibilities.

Behavior

The confused or cautious stroke survivor needs

an ordered environment. The stroke survivor

with poor judgment must be guided when

making important decisions. The apathetic

stroke survivor, on the other hand, should not

live in a world so quiet and simple that there is

little to react to. The caregiver needs to be aware

of the reasons for the stroke survivor’s behavior,

without overlooking the fact that he or she may

also be depressed.

Depression

Depressions is nearly universal among people

who have had a stroke. It can be overwhelming,

affecting the spirit and confidence of everyone

involved. A depressed person may refuse or

neglect to take medications, may not be

motivated to perform exercises which will

improve mobility or may be irritable with others.

The stroke survivor’s depression may dampen the

family’s enthusiasm for helping with recovery

or drive away others who want to help. This

deprives the stroke survivor of the social contacts

which could help dispel depression, and creates a

vicious cycle.

It is possible that as time goes by and a stroke

survivor’s deficits improve, the depression may

lift by itself. Family can help by trying to

stimulate interest in other people, encouraging

leisure activities and providing opportunities

to participate in spiritual activities. If necessary,

chronic depression can be treated with individual

counseling, group therapy or antidepressant

medication.

IEED: Involuntary Emotional

Expression Disorder

Sudden language or crying for no apparent

reason and difficulty controlling emotional

responses, known as emotional lability, affects

many stroke survivors. There may be no

happiness or sadness involved, and the motional

display will end as quickly as it started.

Neglect

Some stroke survivors neglect the side of their

world corresponding to the side of their brain

which was injured by the stroke. Those with leftsided

neglect do not perceive what is on their

left side. For example, the stroke survivor with

left-sided neglect may ignore the left side of the

face when washing or not eat food on the left

side of the plate. If the stroke survivor’s head is

moved to the left, neglected objects may become

apparent. If the plate is turned around, he or she

will finish eating the meal.

Communication Problems

If a stroke causes damage to the language center

in the brain, there will be language difficulties.

Some stroke survivors are unable to understand

or speak at all. Others do not make sense when

they speak. Some can no longer read or write.

Many have difficulty pronouncing words.

Communication problems are among the most

frightening after-effects of stroke for both

the survivor and the family, often requiring

professional help.

27


Daily Task Difficulties

Stroke survivors will find that completing simple

tasks around the house which they took for

granted before the stroke are now extremely

difficult or impossible. Many adaptive devices

and techniques have been designed especially

for stroke survivors to help them retain their

independence and function safely and easily.

The home usually can be modified so that

narrow doorways, stairs and bathtubs do not

interfere with the stroke survivor’s ability to

care for personal needs.

Helpful bathroom devices include grab bars,

a raised toilet seat, a tub bench, a hand-held

shower head, no-slip pads, a long-handled brush,

a washing mitt with pockets for soap, soap-ona-rope,

an electric toothbrush and an electric

razor.

Dressing and Grooming

Dressing oneself is a basic form of independence.

The added value of being neatly and attractively

dressed enhances a stroke survivor’s self-image.

There are many ways to eliminate the difficulties

in getting dressed. Stroke survivors should avoid

tight-fitting sleeves, armholes, pant legs and

waistlines; as well as clothes which must be put

on over the head. Clothes should fasten in front.

Velcro fasteners should replace buttons, zippers

and shoe laces. Devices which can aid in dressing

and grooming include a mirror which hangs

around the neck, a long-handled shoe horn and

a device to help pull on stockings.

Diet, Nutrition and Eating

A low-salt, low-fat, low-cholesterol diet can help

prevent a recurrent stroke. People with high

blood pressure should limit the amount of salt

they eat. Those with high cholesterol or hardening

of the arteries should avoid foods containing

high levels of saturated fats (i.e., animal fats).

28

People with diabetes need to follow their doctor’s

advice on diet. These diet controls can enhance

the benefits of the drugs which may have been

prescribed for control of a specific condition.

Weight control is also important. Inactive people

can easily become overweight from eating more

than a sedentary lifestyle requires. Obesity can

also make it difficult for someone with a strokerelated

disability to move around and exercise.

Some stroke survivors may have a reduced

appetite. Ill-fitting dentures or a reduced sense

of taste or smell can make food unappealing.

The stroke survivor who lives alone might even

skip meals because of the effort involved in buying

groceries and preparing food. Soft foods and

foods with stronger flavors may tempt stroke

survivors who are not eating enough. Nutrition

programs, such as Meals on Wheels, or hot

lunches offered through community centers have

been established to serve the elderly and the

chronically ill.


Special utensils can help people with physicallyimpaired

arms and hands at the table. These

include flatware with built-up handles which

are easier to grasp, rocker knives for cutting food

with on hand and attachable rings which keep

food from being pushed off the plate accidentally.

Stroke survivors who have trouble swallowing

need to be observed while eating so that they

do not choke on their food. The same is true of

those with memory loss who may forget to chew

or to swallow. Tougher foods should be cut into

small pieces.

Skin Care

Decubitus ulcers (sometimes called “bed sores”)

can be a serious problem for stroke survivors

who spend a good deal of time in bed or who

use a wheelchair. The sores usually appear on the

elbows, buttocks or heels.

To prevent bed sores, caregivers should make

sure the stroke survivor does not sit or lie in the

same position for long periods of time. Pillows

should be used to support the impaired arm

or leg. The feet can hang over the end of the

mattress so that the heels don’t rest on the sheet,

or pillows can be put under the knees to prop

them so that the soles of the feet rest flat on the

bed. Sometimes, a piece of sheepskin placed

under the elbows, buttocks or heels can be

helpful. Special mattresses or cushions reduce

pressure and help prevent decubitus ulcers.

Pain

A stroke survivor may suffer pain for many

reasons. The weight of a paralyzed arm can cause

pain in the shoulder. Improperly-fitted braces,

slings or special shoes can cause discomfort.

Often the source of pain can be traced to nerve

damage, bed sores or an immobilized joint.

Lying or sitting in one position too long causes

the body and joints to stiffen and ache.

Sexuality

The quality of a couple’s sexual relationship

following a stroke differs from couple to couple.

Most couples do find that their sexual relationship

has changed, but not all find this to be

a problem. The closeness that a couple shares

before a stroke is the best indicator of how their

relationship will evolve after the stroke. It is

important to remember that sexual satisfaction,

both giving and receiving, can be accomplished

in many ways. Whatever is comfortable and

acceptable between partners is normal sexual

activity.

For the Caregiver

More than half of all caregivers in the United

States are women (59% - 75%). They face

opportunities and challenges as they work to

make quality of life better for their loves ones

who have survived a stroke.

29


Women who care for stroke survivors have special

challenges including:

• Coping with emotional / behavioral changes

• Learning to accept and address

communication difficulties

• Accepting possible physical limitations

• Advocating for rehabilitation and other

health services

• Dealing with changes in home environment

and day-to-day responsibilities

Caregiving can be overwhelming. There are steps

caregivers can take to make the transition from

hospital to home easier on everyone:

• Try to encourage as much independence as

possible

• Allow your loved one to make decisions

• Support participation in leisure activities

• Try to take an occasional break from

caregiving

• Ask for help from family, friends or

community organizations

Stroke recovery is a life-long process filled with

achievements and setbacks. Take the good with

the challenging and embrace life with your loved

ones. Both survivors and caregivers can take

advantage of community resources to improve

their emotional well-being and overall

wellness. Get acquainted with the community

organizations in your area or refer to the back of

this guidebook for national resources for support

and information.

30

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